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03 Oct 2023

NICE NG203, CKD 1.1.21: States to offer testing for CKD using eGFR and ACR to adults with diabetes and other risk factors³

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This non promotional news article is fully funded and developed by Bayer Plc intended for healthcare professionals only.

Listen to this short 1-minute video where Professor Raj Thakkar PCCS President-Elect (CKD representative) and Clinical lead with the National Cardiac Pathways Improvement Programme speaks about why there is no time for complacency in identifying and treating CKD in Type 2 diabetes.

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By 2035, diabetes prevalence is expected to increase to 4.9 million or 9.7%¹. The early diagnosis of CKD in Type 2 diabetes is key in ensuring initiation of appropriate treatment to reduce the risk of further decline in renal function.

The cost of CKD

In 2023, CKD stages 1-5 (excluding ESKD treatments like dialysis and transplantation) will cost the NHS £1.95 billion, with 91% (£1.79 billion) of these costs attributable to CKD stages 3-5 and 9% (£167 million) attributable to CKD stages 1-2 based on a cost-per-diagnosed case basis reported in Kent et al. (2015). This alone represents approximately 1% of the total NHS budget. By 2033, the cost of CKD stages 1-5 is expected to increase by 19% to £2.32 billion annually. The increase in cost is primarily driven by the increasing prevalence of both CKD stages 1-2 and CKD stages 3-5 described in the Epidemiology of CKD section and have not accounted for inflation. These costs are also not inclusive of the KRT costs, which have been modelled separately, and do not include the cost of innovative treatments that may become more common in these populations by 2033³

The cost of dialysis

In 2023,the cost of dialysis for people with ESKD is £1.05 billion, or 0.53% of the NHS budget. A majority of these costs are due to the adult patient population rather than the paediatric population. In addition to the direct cost of dialysis, transport for patients on in-centre dialysis costs approximately £225 million per year. The cost of transport is sometimes incurred by the NHS (e.g. a 2022 study of dialysis in Wales reported that 60% of patients relied on NHS-provided transport), but for the purposes of this report, the cost of transport is included as a separate indirect societal cost².

NICE NG203, CKD 1.1.21: State offer testing for CKD using eGFR and ACR to adults with any of the following risk factors³:

• diabetes
• hypertension
• previous episode of acute kidney injury
• cardiovascular disease*
• structural renal tract disease inc. stones, prostate disease
• gout
• multisystem diseases – e.g., SLE
• family history of end-stage renal disease (GFR category G5) or hereditary kidney disease
• Incidental detection of haematuria or proteinuria


1. Diabetes Prevalence Model. (2016). [online] Public Health England. Available at: [Accessed Jul. 2022].
2. (n.d.). Kidney disease: A UK public health emergency. [online] Available at: [Accessed Oct. 2023].
3. NICE (2021). Chronic kidney disease: assessment and management | Guidance | NICE. [online] Available at:

October 2023

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